Definition An anal fissure is a painful longitudinal cut/ulcer in the anoderm of the distal anal canal extend from dentate line to anal verge where a sentinel pile is common, either anteriorly or posteriorly midline or both, may be acute or chronic, associated with extreme increased in anal tone leading to distressful constipation.
Etiology Anal canal can not distend or accommodate anteriorly due to perennial body and posteriorly due to coccyx as compered to laterally due to ischorectal fossae on passage of hard stool leads to its trauma. The acute traumatic wound become infected leads to chronicity. This traumatic ulcer leads to increased anal tone, so constipation and vicious circle started; pain leads to constipation which leads to exaggeration of ulcer.
Clinical features Simple longitudinal epithelial ulcer situated at anteriorly or posteriorly or both, visible at lower anal canal associated with extreme pain on defecation and later on leading to constipation and vicious circle. Usually a little fresh blood on defecation, rarely profuse bleeding is presentation. Any age from infants to the elderly may be affected but commonly are the young ones.
Differtional diagnosis of atypical presentation are, squamous cell carcinoma, tuberculosis, sexually transmitted diseases, etc; needs biopsy confirmation.
Treatment Simplest, and definite treatment is to over come on increased anal tone by controlled calculated anal dilation under loco regional anesthesia with application of injection SKL in anal sphincter and excised the sentinel pile. After this treatment fissure heals it self and no further medication or precautions are required, just normal life there and then.